Studies of efficacy are designed to investigate the benefits and adverse events of an intervention under ideal and highly controlled conditions. The preferred design for efficacy studies is the RCT using a sham or placebo group as a comparison [49].

Studies of effectiveness seek to examine the outcomes of interventions under circumstances that more closely approximate a real-world setting. Effectiveness studies, therefore, typically use an RCT design, where the new treatment is compared to other interventions (including sham intervention when delivered in a pragmatic plan of management), such as the standard of practice for the patient population being studied [49]. In our review, we classified an RCT as an effectiveness trial if SMT was delivered according to a pragmatic plan of management regardless of the comparison group.

Disorders that are not related to the locomotor system, including those not related to disorders of muscles, bones, joints and associated tissues such as tendons and ligaments. These include but are not limited to asthma, stroke, migraine, dysmenorrhea and hypertension.

Intervening to prevent disease or injury from ever occurring.

Intervening to cure or reduce the impact of a disease or injury that has already occurred.

Intervening to improve the impact of a persistent illness or injury that has lasting effects.

Manual therapy applied to the spine that involves a high velocity, low amplitude impulse or thrust applied at or near the end of a joint’s passive range of motion [50]. Spinal manipulation can be applied manually or with a mechanical device.

Manual treatment applied to the spine that incorporates movements, within a joint’s passive range of motion [50, 51]. Spinal mobilization can be applied manually or with a mechanical device.

Manual or mechanically assisted application of an intermittent or continuous distractive force [52, 53].

In this report, spinal manipulation, spinal mobilization and spinal traction are referred to collectively as “spinal manipulative therapy”.

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